Arrhythmia Mechanisms and Outcomes of Ablation in Pediatric Patients With Congenital Heart Disease

Houck, Charlotte A.; Chandler, Stephanie F.; Bogers, Ad J.J.C.; Triedman, John K.; Walsh, Edward P.; Groot, Natasja M.S. de; Abrams, Dominic J.

doi:10.1161/circep.119.007663

Cited by 26 publications

(18 citation statements)

References 36 publications

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“…Because of early diagnosis and early surgery, the prognosis of patients with CHD has greatly improved in recent decades. However, the ameliorated survival rate is accompanied by an increase in arrhythmia morbidity (35), especially MAT, which is related to a specific type of CHD, palliative surgery, and radical surgical repair (36)(37)(38). Another study demonstrated that 50% of Klippel-Feil syndrome, tetralogy of Fallot, Noonan syndrome, myocarditis, familial hypertrophic obstructive cardiomyopathy, RASopathy syndrome, and Heterotaxy syndrome have a cardiac anatomic abnormality, which facilitates the development of MAT (3,5).…”

Section: Congenital Heart Disease and Cardiac Anatomic Abnormalitymentioning

confidence: 99%

Progress of Pathogenesis in Pediatric Multifocal Atrial Tachycardia

Chen

Wang

et al. 2022

Front. Pediatr.

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Multifocal atrial tachycardia (MAT) is defined as irregular P-P, R-R, and P-R intervals, isoelectric baseline between P waves, and ventricular rate over 100 beats/min. Although the prognosis of pediatric MAT in most patients is favorable, adverse outcomes of MAT have been reported, such as cardiogenic death (3%), respiratory failure (6%), or persistent arrhythmia (7%), due to delayed diagnosis and poorly controlled MAT. Previous studies demonstrated that pediatric MAT is associated with multiple enhanced automatic lesions located in the atrium or abnormal automaticity of a single lesion located in the pulmonary veins via multiple pathways to trigger electrical activity. Recent studies indicated that pediatric MAT is associated with the formation of a re-entry loop, abnormal automaticity, and triggering activity. The occurrence of pediatric MAT is affected by gestational disease, congenital heart disease, post-cardiac surgery, pulmonary hypertension, and infectious diseases, which promote MAT via inflammation, redistribution of the autonomic nervous system, and abnormal ion channels. However, the pathogenesis of MAT needs to be explored. This review is aimed to summarize and analyze the pathogenesis in pediatric MAT.

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Section: Congenital Heart Disease and Cardiac Anatomic Abnormalitymentioning

confidence: 99%

Progress of Pathogenesis in Pediatric Multifocal Atrial Tachycardia

Chen

Wang

et al. 2022

Front. Pediatr.

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“…The CHD patients might have increased VT burden due to surgical scar and hemodynamic abnormalities before or after surgery [12,13]. However, the acute long-term procedural success rate in the CHD patients in this series was good and VT did not recur in all patients during follow-up after last procedure.…”

Section: Discussionmentioning

confidence: 63%

Radiofrequency catheter ablation of ventricular tachycardia in pediatric patients

et al. 2020

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Background Radiofrequency catheter ablation (RFCA) has been accepted as an efficient therapy for tachycardia, and substantial improvement in the outcomes of RFCA in pediatric patients has been seen. However, there is not enough data on the clinical outcomes of RFCA for ventricular tachycardia (VT) in pediatric patients. The objective of this study was to elucidate the efficacy and safety of RFCA for VT in pediatric patients. Methods We performed a retrospective study involving 35 consecutive pediatric VT ablation procedures in 28 patients at a single institution. Results The median age at ablation was 14.0 years (range 6.9–19.2 years). There were 24 patients with a structurally normal heart and four patients with congenital heart disease (CHD). The left ventricular posteroseptal area was the most common site of VT origin (22/28, 78.6%). However, there was an unusual case of VT which involved a papillary muscle as its origin. Acute success was achieved in 30 (85.7%) of 35 procedures. The recurrence rate after successful RFCA was 14.2% (5/35) at a median follow-up of 6.7 years (range 1.0–16.7 years). There were five procedural failures due to the inability to induce VT for complete mapping. Ultimately, long-term success was achieved in 27 patients (96.4%) after repeated procedures and no major complications occurred. Long-term success was associated with VT inducibility (p = < 0.001). Conclusions Difficulty in inducing VT for precise mapping was a significant obstacle to successful RFCA. RFCA was identified as safe and effective therapy to eliminate VT in the selected pediatric VT patients.

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“…Data on TR-associated ventricular arrhythmia are very scarce, focused on Ebstein anomaly. This congenital heart disease can be associated with single or multiple right-sided accessory pathways or Mahaim pathway generating reentrant atrioventricular tachycardia and the risk of life-threatening VA depending of the electrophysiological properties of accessory pathway ( 127 ). Ablation of these arrhythmias can be performed safely in pediatric patients ( 127 ).…”

Section: Tricuspid Regurgitationmentioning

confidence: 99%

“…This congenital heart disease can be associated with single or multiple right-sided accessory pathways or Mahaim pathway generating reentrant atrioventricular tachycardia and the risk of life-threatening VA depending of the electrophysiological properties of accessory pathway ( 127 ). Ablation of these arrhythmias can be performed safely in pediatric patients ( 127 ). Other types of congenital heart disease, with right heart volume overload such as atrial septal defect and repaired tetralogy of Fallot may also lead to VAs ( 128 ).…”

Section: Tricuspid Regurgitationmentioning

confidence: 99%

Arrhythmias in Patients With Valvular Heart Disease: Gaps in Knowledge and the Way Forward

Kubala

Chillou

Bohbot

et al. 2022

Front. Cardiovasc. Med.

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The prevalence of both organic valvular heart disease (VHD) and cardiac arrhythmias is high in the general population, and their coexistence is common. Both VHD and arrhythmias in the elderly lead to an elevated risk of hospitalization and use of health services. However, the relationships of the two conditions is not fully understood and our understanding of their coexistence in terms of contemporary management and prognosis is still limited. VHD-induced left ventricular dysfunction/hypertrophy and left atrial dilation lead to both atrial and ventricular arrhythmias. On the other hand, arrhythmias can be considered as an independent condition resulting from a coexisting ischemic or non-ischemic substrate or idiopathic ectopy. Both atrial and ventricular VHD-induced arrhythmias may contribute to clinical worsening and be a turning point in the natural history of VHD. Symptoms developed in patients with VHD are not specific and may be attributable to hemodynamical consequences of valve disease but also to other cardiac conditions including arrhythmias which are notably prevalent in this population. The issue how to distinguish symptoms related to VHD from those related to atrial fibrillation (AF) during decision making process remains challenging. Moreover, AF is a traditional limit of echocardiography and an important source of errors in assessment of the severity of VHD. Despite recent progress in understanding the pathophysiology and prognosis of postoperative AF, many questions remain regarding its prevention and management. Furthermore, life-threatening ventricular arrhythmias can predispose patients with VHD to sudden cardiac death. Evidence for a putative link between arrhythmias and outcome in VHD is growing but available data on targeted therapies for VHD-related arrhythmias, including monitoring and catheter ablation, is scarce. Despite growing evidences, more research focused on the prognosis and optimal management of VHD-related arrhythmias is still required. We aimed to review the current evidence and identify gaps in knowledge about the prevalence, prognostic considerations, and treatment of atrial and ventricular arrhythmias in common subtypes of organic VHD.

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Arrhythmia Mechanisms and Outcomes of Ablation in Pediatric Patients With Congenital Heart Disease

Cited by 26 publications

References 36 publications

Progress of Pathogenesis in Pediatric Multifocal Atrial Tachycardia

Progress of Pathogenesis in Pediatric Multifocal Atrial Tachycardia

Radiofrequency catheter ablation of ventricular tachycardia in pediatric patients

Arrhythmias in Patients With Valvular Heart Disease: Gaps in Knowledge and the Way Forward

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